CAMILLE FONSECA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125078449

License Status

CANCELLED

Business

Title

First Name

CAMILLE

Last Name

FONSECA

Business Name

CAMILLE FONSECA MD

Original Issue Date

06/24/2021

Effective Date

06/24/2021

Expiration Date

06/23/2024

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

04/01/2021